肺肾双能量CTA筛查肾病综合征患者静脉血栓栓塞的发生率

目的：利用CT筛查肾病综合征患者静脉血栓栓塞事件的发生率及其临床意义。方法：2010年5月-2012年8月974例患者行双能量CT肺动脉成像（CTPA），其中451例肾病综合征患者（包括66例儿童）进行了肺肾联合双能量CT扫描以筛查肺栓塞和肾静脉栓塞。153例患者同时进行了下肢超声检查用于筛查深静脉血栓。记录肺栓塞、肾静脉栓塞、下肢深静脉血栓的发生率及其相互关系。结果：177（39．2％）例患者至少有一个静脉血栓栓塞事件，其中以肺栓塞最常见（149／177，84．1％），76例肺栓塞患者合并肾静脉栓塞，孤立性肺栓塞54例。大多数肺栓塞患者（118／149，79．2％）无临床症状。106例（106／451，23．5％）例患者有肾静脉栓塞，26例（26／153，17．0％）患者有深静脉栓塞。儿童患者静脉血栓事件发生率（13／66，19．7％）低于成人（164／385，42．6％）。在组织学证实的肾病类型中，膜性肾病最常伴有静脉血栓事件（72／153，47．1％）。结论：肺栓塞是肾病综合征患者最常见的血栓并发症且大多是无症状的，常伴有肾静脉血栓或孤立发生，因此对本病的可疑静脉血栓患者的筛查是需要的。

Incidence of venous thromboembolism in patients with nephrotic syndrome based upon combined dual energy pulmonary and re- nal CT angiography

Objective： To determine the prevalence of venous thromboembolism （VTE） by computed tomography （CT） screening in a large consecutive cohort of patients with nephrotic syndrome （NS）. Methods： Of 974 patients under- going dual energy CT pulmonary angiography between May 2010 and August 2012,451 patients with nephrotic syndrome （24-hour urine protein 〉3.5g） included 66 chlidren were included in this study. Combined CT pulmonary angiography was used to screen for pulmonary embolism （PE） and renal CT venography for renal vein thrombosis （RVT）. Results of lower extremity ultrasonography for deep vein thrombosis （DVT） were available in 153 patients. Prevalence of PE, RVT, and DVT was computed according to underlying renal pathology. Results： 177/451 （39. 2%） patients had at least one VTE manifestation, with PE as the most common （149/177,84.1%）. PE was associated with RVT in 76 and isolated in 54 pa- tients. Most patients with PE （118/149,79.2 %） were asymptomatic. One hundred and six （106/451,23.5 % ） patients had RVT and 26/153 （17.0%） had DVT. Children with NS had the lower rate （13/66,19.7%） of VTE than adults （164/385, 42.6 %）. Of histology proven nephrotic types, membranous nephropathy was the most common histopathology associated with VTE （72/153,47.1 % ）. Conclusion： PE is the most common VTE manifestation in patients with NS, and the patients with PE are often asymptomatic and should be evaluated for.